Ch,ch,changes. The next couple of months are going to see a sea change in the management of commissioning across England. The appointments to the NHS Commissioning Board (NHSCB) sectors are being made. Appointing to these four posts will allow the wave of appointments to the local offices, to be renamed as local area teams, to be […]
Category: Columnists
Tiago Villanueva: Cutting edge primary care in Denmark
As a locum GP, I tend to have limited contact with the permanent staff of the practices I work in, and I therefore rely almost entirely on myself to look after my professional development (there is currently no revalidation scheme for doctors in Portugal). Once a year I try to visit and shadow a prominent […]
Richard Smith: Are we too concerned with confidentiality? A fable
I am the chief medical officer of our family. I am the bridge between my family members, some of them eccentric and one of them demented, and an unforgiving health system. Many doctors—indeed, anybody familiar with the strange language and rigidities of health systems—fulfil the same role, and it gives us some useful bottom up […]
Richard Smith: Disclosure of conflicts of interest may increase bias
I’ve worried that disclosing conflicts of interest may be counterproductive ever since we did an experiment that showed that readers of articles with declared conflicts discounted not only the believability of the results, but every aspect of the paper, including its importance and originality. Now my worries are increased by a paper in JAMA and […]
Richard Smith: Our need for clockware and swarmware
Tackling the global pandemic problem of non-communicable disease (NCDs) is a complex problem that needs clockware and swarmware. I imagine that most BMJ readers have no idea what that sentence means, but read a few more paragraphs and you may learn something useful. Problems, said Sian Williams, executive officer of the International Primary Care Research […]
Edzard Ernst: Pascal’s Wager and alternative medicine
Blaise Pascal (1623-1662) argued that, because it is impossible to either prove or disprove the existence of God, it would be best to wager in favour of his existence. In case one got it wrong, little would be lost; in case one was correct, everything was gained. The same logic seems to be employed by […]
Tracey Koehlmoos: Bringing systematic reviews with a development focus to South Asia
A substantial body of evidence exists to answer many of the questions asked by policymakers and development partners in low and middle income countries (LMIC). However, evidence is often scattered, inaccessible, and rarely presented in a form that provides an indication of the quality of evidence. Systematic reviews in all sectors have the potential to […]
Richard Smith: Doctors are not interested in health or prevention
“Doctors are not interested in health” is one of my many wild generalisations. My evidence is my experience, a 40 year collection of anecdotes, and the observation that a thousand page medical textbook usually comprises five desultory pages on health and 995 pages detailing disease. Now I have further evidence. I’ve just attended the World […]
Tiago Villanueva: Austerity eroding Portuguese healthcare
In 1960, Portugal’s infant mortality rate was 77.5 deaths per 1000 live births, which is comparable to that of many Sub Saharan African countries today. In 2010, Portugal’s infant mortality rate was 2.5 deaths per 1000 live births, one of the lowest in Europe and in the world. […]
Martin McShane: 80:20
We are working through trying to understand exactly how commissioning support (CSS) will work with Clinical Commissioning Groups (CCGs). At a recent time out the lead manager for the CSS presented on the progress being made with Greater East Midlands CSS (GEM). They highlighted the scale of work that is required with the 277 tasks […]